1w
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HEDIS Audit Quality Manager (State and NCQA)
Atlanta or Woodland Hills or Waukesha or Hanover or Indianapolis or Miami or Cincinnati or Grand Prairie or Chicago or Iselin or Lake Mary or Woburn or Mendota Heights
$99k-$163k/yr HybridFull Time
3+ YOEBA/BS in a health care field and minimum 3 years healthcare experience plus 3 years QA/QI experience or equivalent; strong knowledge of NCQA HEDIS audit guidelines, audit management, project planning, and data analysis.
1d
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Clinical Quality Consultant
Newton, Massachusetts, United States
$92k-$164k/yr HybridFull Time
5+ YOE5+ years leading quality improvement and data analysis in managed care or provider settings; experience with HEDIS, NCQA, Star Ratings; intermediate Microsoft Office; commitment to health equity.
Microsoft Outlook, Microsoft Word, Microsoft PowerPoint, Microsoft Excel, HEDIS, NCQA, CAHPS, CMS Star Ratings
4w
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Medical Director
Boston or Massachusetts or New Hampshire
$173k-$250k/yr RemoteFull Time
8+ YOEMD/DO with active/unrestricted MA and NH licensure (or ability to obtain), 8+ years related experience (min 5 clinical, min 3 in medical management), board certification, knowledge of InterQual, NCQA, HEDIS, Medicare/Medicaid, strong communication and leadership.
InterQual, NCQA, HEDIS, E-Verify
3mo
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Payer Healthcare Data Scientist, Manager
Boston, Massachusetts, United States
$99k-$232k/yr OnsiteFull Time
6+ YOEBachelor’s degree; 6+ years in data science and ML; leadership experience; healthcare/payer analytics; NCQA HEDIS familiarity; travel up to 80%.
2mo
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BH Provider Engagement Specialist III
Boston, Massachusetts, United States
$72k-$116k/yr HybridFull Time
5+ YOEBachelor’s degree in a healthcare field; 5 years healthcare experience incl provider relations/contracting; managed care experience required; NCQA PCMH experience preferred.
Microsoft Outlook, Microsoft Word, Microsoft Excel
1mo
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Senior Clinical Quality Performance Specialist
Manchester, New Hampshire, United States
RemoteFull Time
5+ YOERN required, Associate's degree or equivalent, 5+ years in clinical/service quality improvement and managed care, intermediate/expert Excel and SAS, NCQA experience preferred.
Microsoft Excel, SAS
1mo
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Credentialing Specialist 40hrs 8am-4:30pm Days
Lawrence, Massachusetts, United States
$24-$37/hr OnsiteFull Time
Associates degree required; CPCS or CPMSM certification preferred. Responsible for primary source verification, new appointment and reappointment processing, and preparation of complete credentialing files in compliance with Joint Commission and NCQA standards.
Echo
1mo
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Credentialing Specialist 40hrs 8am-4:30 Days
Lawrence, Massachusetts, United States
$24-$37/hr HybridFull Time
Associate degree required. Perform primary source verification, prepare appointment/reappointment files, ensure compliance with Joint Commission and NCQA, support meetings and credentialing operations. CPCS or CPMSM and Echo experience preferred.
Echo
3w
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Sr. Manager Corporate Compliance-Special Needs Plans
Ohio or Irving or Scottsdale or Woonsocket or Hartford or Northbrook
$83k-$183k/yr HybridFull Time
7+ YOE2+ Mgmt7+ years Medicare/Medicaid compliance experience (SNP focus), 2+ years project management, knowledge of CMS/NCQA/regulations, audit and corrective action experience, strong analytical and communication skills, bachelor’s or equivalent.
Microsoft Office, Archer
1w
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RN Case Manager
Hingham, Massachusetts, United States
$44-$54/hr OnsiteFull Time
3+ YOEActive MA licensure appropriate to role (RN, LMHC, LICSW, LCSW),3+ years clinical experience, case management experience preferred, knowledge of care management/NCQA standards, strong communication and clinical documentation skills.
1d
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Associate Director, Provider Network Operations & Planning
Boston, Massachusetts, United States
$115k-$145k/yr HybridFull Time
8+ YOEBachelor's required (Master's preferred),8+ years provider network/data/credentialing experience,2+ years with credentialing applications,knowledge of URAC/NCQA and federal program requirements,ability to obtain U.S. government security clearance.
1mo
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Provider Enrollment & Credentialing Specialist
Boston, Massachusetts, United States
$18-$32/hr HybridFull Time
2+ YOEHigh school diploma/GED, 2+ years credentialing or payer enrollment experience, intermediate Microsoft Word and Excel, familiarity with NCQA/CMS standards, strong attention to detail, ability to work independently and follow HIPAA privacy rules.
Microsoft Office, Microsoft Excel, Microsoft Word, Resolute, MD Staff
1mo
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BH Medical Director (Per Diem)
Boston or Massachusetts or New Hampshire
$150/hr RemoteContract, Part Time
8+ YOEPhysician (MD/DO) with 8+ years related experience (≥5 years clinical); managed care/medical management experience preferred. Requires active/unrestricted MA and NH physician licensure (or ability to obtain), board certification in psychiatry (Child & Adolescent specialty preferred), and ability to perform clinical utilization and appeals reviews.
InterQual, HEDIS, NCQA, E-Verify